Splenic torsion with rupture of spleen is an extremely rare phenomenon. The clinical picture mimics several common conditions which are causes of acute abdomen and so it is seldom detected pre-operatively. An 18 year old female patient was admitted with an acute abdomen and shock. The provisional diagnosis was of a ruptured ectopic pregnancy. Peri-operatively we found a spontaneous rupture of the spleen following torsion along with early intrauterine pregnancy. Splenectomy was carried out and patient recovered well. Our report confirms that this rare entity can present as an acute abdomen which is very difficult to diagnose preoperatively and can masquerade as ruptured ectopic pregnancy in women of childbearing age group.
BACKGROUND Cesarean section (CS) rates have been increased to as high as 25 to 30% in many areas of the world. Risk of postpartum haemorrhage increases in cases of cesarean section & PPH is a major cause of maternal morbidity & mortality. Routinely uterotonics are used for active management of third stage of labour. Tranexamic acid by its antifibrinolytic action further reduces blood loss. This study will evaluate the efficacy and safety of tranexamic acid in combination with uterotonic drugs in reducing the blood loss after placental delivery following lower segment caesarean section (LSCS). METHODS A randomized, case controlled, prospective study was conducted on 100 women undergoing lower segment cesarean section (LSCS) at term between 37 and 41 wks. and have been studied prospectively. They are divided in two groups, 50 control &50 cases. Cases (50) were given tranexamic acid immediately before LSCS along with 10 units of oxytocin whereas control group were given 10 units of oxytocin alone after delivery of foetus. Blood loss was collected and measured during two periods. RESULTS The patient characteristics, namely age, height, weight, gestational age and gravidity in two groups were similar which was statistically insignificant. There was no episode of thrombosis in the study. Tranexamic acid significantly reduced the quantity of the blood loss from time of placental delivery to 2 hours postpartum (p<0.001) and from end of LSCS to 2 hours postpartum (p<0.001). However there was no statistical difference in quantity of blood loss from time of placental delivery to end of LSCS in both groups. CONCLUSIONS A safe dose of Tranexamic acid has an effective role in reducing blood loss during LSCS without causing adverse reaction. Thus the drug can be used effectively in reducing maternal morbidity and mortality during LSCS.
A BS T R A C T BACKGROUNDSpinal anesthesia has been shown to be easy, rapid and safe technique for caesarean section. Both Ramosetron and Ondansetron are increasingly being used for prevention and treatment of nausea and vomiting. We wanted to evaluate the efficacy of Ramosetron and Ondansetron in prevention of nausea and vomiting intraoperatively and postoperatively in LSCS patients under spinal anesthesia. METHODSThis was a randomized, double blind study conducted among 60 female patients. They received either Ondansetron (4 mg) or Ramosetron (0.3 mg) intravenously 10 minutes before administration of spinal anesthesia. All patients were subjected to elective caesarean section under spinal anesthesia. They were randomly allocated into two groups namely control group (A) 30 patients who received Inj. Ondansetron 4 mg/IV and study group (B) of 30 patients who received Ramosetron 0.3 mg/IV. The patients were observed intraoperatively, in the recovery room and the ward up to 24 hours for episodes of nausea and vomiting. Rescue anti emetic was given if PONV score 2 was recorded. Side effects such as dizziness, headache, sedation or extrapyramidal reaction were noted. RESULTSNausea and vomiting were noticed in 33.3% of the control group compared to 20% of the study group. Rescue antiemetic with PONV score 2 was given to 13.3% and 6.66% of the control and study groups respectively. Side effects were minimal with satisfaction expressed by 60% of control and 80% of the study population. CONCLUSIONSRamosetron is quite effective to prevent nausea and vomiting in LSCS patients under spinal anaesthesia. It reduces the incidence of nausea and vomiting intraoperatively and in the immediate postoperative period with minimal side effects and with good patient satisfaction.
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